Nokea
The nurse assesses a postoperative patient who is receiving morphine through patientcontrolled analgesia (PCA). Which information is most important to report to the health care provider?
- A. The patient complains of nausea after eating.
- B. The patient's respiratory rate is 10 breaths/minute.
- C. The patient has not had a bowel movement for 3 days.
- D. The patient has a distended bladder and has not voided.
Correct Answer: B
Rationale: The patient's respiratory rate indicates a need to decrease the PCA dose or change the medication in order to avoid further respiratory depression. The other information also may require intervention, but is not as urgent to report as the respiratory rate.
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The nurse is caring for a patient with cancer pain that the patient describes as at 'level 8 (0-10 scale), deep, and aching.' Which of the following prescribed medications should the nurse administer first?
- A. Fentanyl patch
- B. Ketorolac tablets PO
- C. Hydromorphone IV
- D. Acetaminophen suppository
Correct Answer: C
Rationale: The patient's pain level indicates that a rapidly acting medication such as an IV opioid is needed. The other medications also may be appropriate to use, but will not work as rapidly or as effectively as hydromorphone IV.
A patient with persistent abdominal pain has learned to control the pain with the use of imagery and hypnosis. A family member asks the nurse how these techniques work. Which of the following reasons provide the basis for the nurse's response in relation to the effectiveness of these strategies?
- A. Impact the cognitive and affective components of pain.
- B. Increase the modulating effect of the efferent pathways.
- C. Prevent transmission of nociceptive stimuli to the cortex.
- D. Slow the release of transmitter chemicals in the dorsal horn.
Correct Answer: A
Rationale: Cognitive therapies impact on the perception of pain by the brain rather than affecting efferent or afferent pathways or influencing the release of chemical transmitters in the dorsal horn.
These medications are prescribed by the health care provider for a patient who uses long-acting morphine for persistent back pain, but still has ongoing pain. Which of the following medications should the nurse question?
- A. Morphine
- B. Pentazocine
- C. Celecoxib
- D. Dexamethasone
Correct Answer: B
Rationale: Opioid agonist-antagonists can precipitate withdrawal if used in a patient who is physically dependent on agonist drugs such as morphine. The other medications are appropriate for the patient.
These medications are ordered for an older-adult patient with arthritis in both hips who is complaining of level 3 (0-10 scale) hip pain while ambulating. Which medication should the nurse use as initial therapy?
- A. Acetylsalicylic acid 650 mg orally
- B. Naproxen 200 mg orally
- C. Oxycodone 5 mg orally
- D. Acetaminophen 650 mg orally
Correct Answer: D
Rationale: Acetaminophen is the best first-choice medication. The principle of 'start low, go slow' is used to guide therapy when treating elderly adults because the ability to metabolize medications is decreased and the likelihood of medication interactions is increased. Nonopioid analgesics are used first for mild to moderate pain, although opioids may be used later. Acetylsalicylic acid and the NSAIDs are associated with a high incidence of gastrointestinal bleeding in elderly patients.
The nurse visits a hospice patient and assesses a respiratory rate of 8 breaths/minute and the patient states 'I am having severe pain.' Which of the following interventions should the nurse implement at this time?
- A. Inform the patient that increasing the morphine will cause the respiratory drive to fail.
- B. Administer a nonopioid analgesic, such as a nonsteroidal anti-inflammatory drug (NSAID), to improve patient pain control.
- C. Tell the patient that additional morphine can be administered when the respirations are 12.
- D. Titrate the prescribed morphine dose upward until the patient indicates adequate pain relief.
Correct Answer: D
Rationale: The goal of opioid use in terminally ill patients is effective pain relief regardless of adverse effects such as respiratory depression. The rule of double effect provides ethical justification for administering an increased morphine dose to provide effective pain control even though the morphine may further decrease the patient's respiratory rate. A nonopioid analgesic like ibuprofen would not provide adequate analgesia or be absorbed quickly.